| NPI | 1316316714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015726) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3510) |
| 225100000X Physical Therapist (Licence: WY 1824) | |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2021-01-25 |